Background
Recent behavioral studies have shown the clinical relevance of meditation in the treatment of stress-related physiological and psychological illnesses. Kabat-Zinn et al. (1998) found that audio-induced mindfulness meditation reduced stress and increased the rate of healing of psoriatic lesions in patients with psoriasis. Krisanaprakornkit et al. (2006) reviewed a variety of meditation techniques on the effect of stress-related anxiety disorders and found that most meditation approaches can help patients self-regulate anxiety symptoms in a variety of anxiety conditions. In an extensive literature review comprising hundreds of studies conducted in the past 20 years, Jacobs (2001) also found that relaxation techniques and mind-body interventions are clinically effective in the treatment of a variety of health problems associated with stress. For example, meditation has been shown to improve prognosis in coronary heart disease, enhance the immune response, and restore homeostasis. Furthermore, meditation was found to be more effective than antidepressant medication in the treatment of major depression. However, Jacobs stresses that meditation therapies are more effective when used as adjuvants to standard medical care.
Tsai (2004) studied the long-term effect of audio-visual relaxation therapy (AVRT) in conjunction with meditation in the treatment of anxiety in cardiac patients and found that AVRT combined with meditation reduced anxiety, improved sleep and promoted relaxation in this group of patients. Chen et al. (2009) examined the efficacy of progressive muscle relaxation training in the treatment of anxiety in patients with acute schizophrenia and found the effectiveness of this therapy depended on the quality of the patient’s mental status at the time of intervention.
Meditation can induce various physiological and biochemical changes some of which enable the intrinsic human potential to visualize light (Brown, Forte & Dysart, 1984) and people with extensive meditation training are able to more readily perceive this innate light. Virtual Light and Sound Machine (VLSM) meditation therapy introduces patients to the experience of veteran meditators while conferring immediate therapeutic benefits.
Q1. What is the effect of VLSM therapy on state anxiety levels, as measured by the STAI?
Q2. What is the effect of VLSM therapy on perceived stress levels, as measured by the PSS?
Research Method
This will be a prospective, randomized, controlled clinical trial designed to examine the effects of VLSM meditation therapy (Solfanelli, 2010) on state anxiety levels and perceived stress levels. As previously noted, state anxiety will be operationally defined as scores on Spielberger’s State-Trait Anxiety Inventory (STAI), whereas stress will be operationally defined as scores on the Perceived Stress scale (PSS).
Audio-visual stimulation (AVS) therapy was selected over other popular forms of meditation therapy, including therapies such as Joacobson’s Progressive Muscle Relaxation (Conrad & Roth, 2006), mindfulness-based stress reduction (MBSR) therapy (Brady et al, 2012) and Paced Breathing Meditation (PBM) therapy (Prasad et al, 2011).
This decision was based upon the fact that although there is subsequent muscle relaxation with AVS, AVS seems to more closely approximate the experience of mindfulness mediation (MM), as AVS appears to elicit a meditative experience, via a momentary suspension of any mental intending (Budzynski, 2006).
Utilizing G*Power software (Faul, Erdfelder, Lang, Buchner, 2007), it was determined that an alpha level of 95%, a confidence interval of 15, and an adequate will require a sample size of 135 volunteer subjects. The subjects will be randomly assigned to one of three treatment groups; namely, a TBD VLSM group, a TBD VLSM group, and a control group. All groups will complete a pre- and post-test of the STAI and PSS to determine their state anxiety and perceived stress levels.
The STAI was chosen as an assessment instrument for this research, since it is a well-researched scale that is the most relied upon self-report measure of anxiety (Spielberger, et al., 1995). Additionally, the STAI has shown positive test-retest reliability (Spielberger, Gorsuch, & Lushene, 1970). The PSS was also chosen as an assessment instrument for this research, since it is constructed to determine the extent to which an individual evaluates their life experiences as stressful events. The PSS’s 10-item subjective questionnaire has an index that has been empirically corroborated (Cohen, Kamarch, & Mermelstein, 1983).
Informed consent will be obtained from all participants and Institutional Review Board approval will be obtained from both the originating research institution and the university from which subjects will be selected (United States National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978).
Subjects from the general pool of adult male and female student volunteers from a small northeastern Pennsylvania university will be randomly assigned to a TBD VLSM experimental group, a TBD VLSM experimental group, and a control group. Volunteers will be selected from both the school's traditional (day program) and non-traditional (evening program) programs, and the age of the volunteers will range from 20 to 60.
VLSM was designed to entrain brainwaves with precisely timed, flickering lights, and there exists a risk that flickering lights might induce seizures in subjects undergoing VLSM therapy; therefore, in adherence with the Belmont Report’s ethical principles and guidelines for the protection of human subjects of research (United States National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 1978), all subjects will be pre-screened for the rare possibility of a diagnosis of photosensitive seizure disorder or photosensitive epilepsy (Erba, n.b.). According to Erba (n.b.) there is an overall risk of 0.0005% for an undiagnosed person to experience this type of adverse medical reaction to flickering lights and those diagnosed with photosensitive seizure disorder or photosensitive epilepsy experience their first light-induced seizure before age 20.
The VLSM experimental group will be seated with their eyes closed in a dimly lit and quiet room two feet away from their respective computer monitors and exposed to VLSM therapy for a period of 10 minutes. The software pulses the monitor so that the flickering is experienced behind the subjects’ closed eyelids and its effect is to induce a feeling of deep relaxation within a few minutes. The subjects will experience the effects of the VLSM meditation software (independent variable) preset to the theta-4-y setting.
The mindfulness meditation experimental group will listen to a pre-recorded mindfulness meditation for approximately fifteen minutes. The audio meditation will be publicly accessed from the University of North Carolina at Chapel Hill website: ftp://ftp.unc.edu/pub/dsa/shs/cws/cws_relax4.mp3. The control group will be seated in a quiet waiting room and told they have been wait listed for the next opportunity to participate. The dependent variable is the subjects' responses to the STAI and PSS.
This research will contribute to theory insomuch as it will support or reject results from previous research that demonstrated that flicking lights have the ability to create a reduction in state anxiety (Brignolo, 2007).
Measurement
The Statistical Package for the Social Sciences (SPSS version 17) will be used to analyze STAI and PSS scores. Statistical analyses will include a two-tailed distribution for independent sample means and a between-group repeated measures multiple analysis of covariance (MANCOVA). The hypothesis is that VLSM meditation will induce relaxation and thus improve STAI and PSS scores in healthy volunteers.
All participants of this research study will be administered pre- and post-test, self-report measures of stress, trait anxiety, and state anxiety by means of the following instruments: the Perceived Stress Scale (PSS) and Spielberger’s State-Trait Anxiety Inventory (STAI).
The Perceived Stress Scale (PSS) is constructed to determine the extent to which an individual evaluates their life experiences as stressful events. It consists of a 10-item subjective questionnaire, which has an index that has been empirically corroborated in other studies (Cohen, Kamarch, & Mermelstein, 1983).
Spielberger’s State-Trait Anxiety Inventory (STAI) consists of two subscales; one measures state anxiety, the other measures trait anxiety. This subjective instrument relies upon a string of scores ranging from 20 to 80. The greater scores are indicative of a higher level of experienced anxiety. The STAI demonstrates concurrent validity with its anxiety scale and other standardized instruments that measure anxiety. For example, the Anxiety Scale Questionnaire (ASQ) has a positive correlation score of 0.73, while the Manifest Anxiety Scales (MAS) has a 0.85 correlation (Spielberger, et al., 1995). According to Rule and Traver (1983), the STAI has also shown positive test-retest reliability.
References
Adrian, E. D. & Matthews, B. H. (1943). The Berger rhythm: Potential changes from the occipital lobes of man. Brain, 57, 355-385.
American Psychological Association (2005). A new health care prescription: Companies are finding that investing in employees' emotional well-being can mean a healthier bottom line, Fortune, 151(2), S1-S5.
Barnes, P. M., Powell-Griner, E., McFann, K., & Nahin, R. L. (2004). Complementary and alternative medicine use among adults: United States 2002. Advance Data, 343(1), 1-20. Retrieved from http://nccam.nih.gov/news/camstats/2002/report.pdf
Benson, H., Ams, P. A., & Hoffman, J. W. (1981). The relaxation response and hypnosis. International Journal of Clinical and Experimental Hypnosis, 29(3), 259-270. DOI:10.1080/00207148108409160
Berg, K. & Siever, D. (2009). A controlled comparison of audio-visual entrainment for treating seasonal affective disorder. Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience, 13(3), 166-175. doi:10.1080/10874200903107314
Brady S, O'Connor N, Burgermeister D, Hanson P. (2012). The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit. Perspect Psychiatr Care. 2012 Jul;48(3):129-37. doi: 10.1111/j.1744-6163.2011.00315.x.
Brignolo, L. (2007). Audio-visual stimulation and mindfulness meditation training: The effects of digital meditation on attention, electro-cortical activity, and well-being. Available from ProQuest Dissertations and Theses database. (AAT No. 3271449)
Brown D, Forte M, Dysart M. (1984) Differences in visual sensitivity among mindfulness meditators and non-meditators. Percept Mot Skills. 1984 Jun;58(3):727-33.
Budzynski, T. (2006). The clinical guide to sound and light. Retrieved from http://www.stanford.edu/group/brainwaves/2006/theclinicalguidetosoundandlight.pdf
Budzynski, T., Jordy, J., Budzynski, H., Tang, H., & Claypoole, K. (1999). Academic performance enhancement with photic stimulation and EDR feedback. Journal of Neurotherapy, 3(1),11-21. Retrieved from http://www.mindmodulations.com/resources/Study-biolight.pdf
Campbell, J. K., Penzien, D. B., Wall, E. M. (2010). Evidenced-based guidelines for migraine headache: Behavioral and physical treatments. Retrieved from http://www.aan.com/professionals/practice/pdfs/gl0089.pdf
Cantor, D. S. & Stevens, S. (2009). QEEG correlates of auditory-visual entrainment treatment efficacy of depression. Journal of Neurotherapy, 13(1), 100-108.
Cardoso, R., de Souza, E., Camano, L., & Leite, J. (2004). Meditation in health: An operational definition. Brain Research Protocols, 14(10), 58-60. doi:10.1016/j.brainresprot.2004.09.002
Chen WC, Chu H, Lu RB, Chou YH, Chen CH, Chang YC, O'Brien AP, & Chou KR (2009). Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia. J Clin Nurs. 18(15):2187-96.
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24(4), 385-396. Retrieved from http://www.psy.cmu.edu/~scohen/globalmeas83.pdf.
Conrad, A., & Roth, W. (2006). Muscle relaxation therapy for anxiety disorders: It works but how? Journal of Anxiety Disorders 21(1), 243–264. doi:10.1016/j.janxdis.2006.08.001
Du Plessis, A. (2010). Combining Brainwave Entrainment, Mind Programming Techniques and Tracking Technologies to Help Individualize and Optimize the Soft Skills Development of University Students. In J. Sanchez & K. Zhang (Eds.), Proceedings of World Conference on E-Learning in Corporate, Government, Healthcare, and Higher Education 2010 (pp. 62-67). Chesapeake, VA: AACE. Retrieved from http://www.editlib.org/p/35511.
Dusek, J. A., & Benson, H. (2009). Mind-body medicine: A model of the comparative clinical impact of the acute stress and relaxation responses. Minnesota Medicine, 92(5), 47-50. Retrieved from http://www.ncbi.nlm.nih.gov
Dusek, J. A., Hibberd, P. L., Buczynski, B., Chang, B., Dusek, K. C., Johnston, J. M.,Zusman, R. M. (2008). Stress management versus lifestyle modification on systolic hypertension and medication elimination: A randomized trial. The Journal of Alternative and Complementary Medicine, 14(2), 129-138. doi:10.1089/acm.2007.0623
Elkins, G.R., & Rajab, M.H. (2004). Clinical hypnosis for smoking cessation: Preliminary results of a three-session intervention. The International Journal of Clinical and Experimental Hypnosis, 52(1), 73-81. Retrieved from http://taylorandfrancis.metapress.com
Erba, G. (n.d.). Shedding light on photosensitivity, one of epilepsy’s most complex conditions. Retrieved from the Epilepsy Foundation website http://www.epilepsyfoundation.org/about/photosensitivity/gerba.cfm
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191. doi:10.3758/BF03193146
Galvin, J. A., Benson, H., Deckro, G. R., Fricchione, G. L., & Dusek, J. A. (2006). The relaxation response: Reducing stress and improving cognition in healthy aging adults. Complementary Therapies in Clinical Practice, 12(1), 186-191. doi:10.1016/j.ctcp.2006.02.004
Goldin, P. R., & Gross, J. J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion, 10(1), 83–91. doi:10.1037/a0018441
Gorini, A., Pallavicini, F., Algeri, D., Repetto, C., Gaggioli, A., & Riva, G. (2010). Virtual reality in the treatment of generalized anxiety disorders. Studies in Health Technology and Informatics, 154(1), 39-43. doi:10.3233/978-1-60750-561-7-39
Gupta, N., Khera, S., Vempati, R. P., Sharma, R., & Bijlani, R. L. (2006). Effect of yoga based lifestyle intervention on state and trait anxiety. Indian Journal of Physiology and Pharmacology, 50(1), 41-47.
Howard, C. E., Graham, L. E., Wycoff, S. J. (1986). A comparison of methods for reducing stress among dental students. Jouranl of Dental Education, 50(9), 542-544.
Huang, L., & Charyton, C. (2008). A comprehensive review of the psychological effects of brainwave entrainment, Alternative Therapies in Health and Medicine, 14(5), 38-49.
Hutchison, M. (1986). Megabrain. New York: Beech Tree Books. William Morrow.
Jacobs GD (2001). Clinical applications of the relaxation response and mind-body interventions. J Altern Complement Med. 7 Suppl 1:S93-101.
Kabat-Zinn J, Wheeler E, Light T, Skillings A, Scharf MJ, Cropley TG, Hosmer D, & Bernhard JD (1998). Influence of a mindfulness meditation-based stress reduction intervention on rates of skin clearing in patients with moderate to severe psoriasis undergoing phototherapy (UVB) and photochemotherapy (PUVA). Psychosom Med 60 (5): 625-32.
Kim, D., Bae, H., & Park, Y. C. (2008). Validity of the subjective units of disturbance scale in EMDR. Journal of EMDR Practice and Research, 2(1), 57-62. doi:10.1891/1933-3196.2.1.57
Krisanaprakornkit T, Krisanaprakornkit W, Piyavhatkul N,& Laopaiboon M. (2006). Meditation therapy for anxiety disorders. Cochrane Database Syst Rev. 2006 Jan 25; (1):CD004998. Epub 2006 Jan 25.
Kroger, W. S. & Schneider, S. A. (1959). An electronic aid for hypnotic induction: A preliminary report. International Journal of Clinical and Experimental Hypnosis, 7, 93-98.
Landgraf, M. (2005). Mind States: An Introduction to Light and Sound Technology (2nd ed.). Granada Hills: Little Minnie’s House.
Lewerenz, C. (1963). A factual report on the brain wave synchronizer. Hypnosis Quarterly, 6(4), 23.
Manocha, R. (2010). Compliance with treatment. Retrieved from http://www.researchingmeditation.org/blog/compliance-with-treatment.html
Micheletti, L. S. (1999) .The Use of Auditory and Visual Stimulation for the Treatment of Attention Deficit Hyperactivity Disorder in Children. Retrieved from http://www.neuromedicstechnology.com/Library/final69.pdf
Mindlin, G. & Evans, G. (2009). Brain music treatment: A brain/music interface. In Introduction to Quantitative EEG and Neurofeedback: Advanced Theory and Applications (2nd ed.) (T. H. Budzynski, H. R. Budzynski, J. R. Evans, & A. Abarbanel, eds.), pp. 225-238. Waltham: Academic Press.
Moadel, A. B., Shah, C., Wylie-Rosett, J., Harris, M. S., Patel, S. R., Hall, C. B., Sparano, J. A. (2007). Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: Effects on quality of life. Journal of Clinical Oncology, 25(28), 4387-4395. doi:10.1200/JCO.2006.06.6027
National Registry of Evidence-Based Practices and Programs (2007). NREPP Review Criteria. Retrieved from http://www.nrepp.samsha.gov/review-criteria.htm
Novella, S. (2008). Brainwave Entrainment and Marketing Pseudoscience. Retrieved from http://theness.com/neurologicablog/index.php/brainwave-entrainment-and-marketing-pseudoscience/
Ospina, M. B., Bond, T. K., Karkhaneh, M., Tjosvold, L., Vandermeer, B., Liang, Y.,Klassen, T. P. (2007). Meditation practices for health: State of the research. Retrieved from http://www.ahrq.gov
Ossebaard, H. C. (2000). Stress reduction by technology? An experimental study into the effects of brainmachines on burnout and state anxiety. Applied Psychophysiology and Biofeedback, 25(2), 93-101. doi:10.1023/A:1009514824951
Padmanabhan, R., Hildreth, A. J., & Laws, D. (2005). A prospective, randomised, controlled study examining binaural beat audio and pre-operative anxiety in patients undergoing general anaesthesia for day case surgery. Anaesthesia, 60(1), 874–877. doi:10.1111/j.1365-2044.2005.04287.x
Petrak, F., Herpertz, S., Albus, C., Hirsch, A., Kulzer, B., Kruse, J. (2005). Psychosocial factors and diabetes mellitus: Evidence-based treatment guidelines, Current Diabetes Reviews, 1(3), 1-16. doi:10.2174/157339905774574329
Pigott, E., Alter, G., Marikis, D., & Boriskin, J. (2009). Frequency-based light &/or sound neurotherapy (LSN) research: A meta-analysis. Retrieved from
Prasad K, Wahner-Roedler DL, Cha SS, Sood A (2011). Effect of a single-session meditation training to reduce stress and improve quality of life among health care professionals: a "dose-ranging" feasibility study. Altern Ther Health Med.17(3):46-9.
Rubia, K. (2009). The neurobiology of Meditation and its clinical effectiveness in psychiatric disorders. Biological Psychology, 82(1), 1-11. doi:10.1016/j.biopsycho.2009.04.003
Rule, W.R. and Traver, M.D. (1983). Test-retest reliabilities of State-Trait Anxiety Inventory in a stressful social analogue situation. Journal of Personality Assessment, 47(3), 276-277.
Sadove, M.S. (1963). Hypnosis in anaesthesiology. Illinois Medical Journal, 39-42.
Schreiner, I. & Malcolm, J. P. (2008). The benefits of mindfulness meditation: changes in emotional states of depression, anxiety, and stress. Behaviour Change, 25(3), 156-168. doi:10.1375/bech.25.3.156
Sephton, S. E., Salmon, P., Wissbecker, I., Ulmer, C., Floyd, A., Hoover, K., & Studts, J. (2007). Mindfulness meditation alleviates depressive symptoms in women with fibromyalgia: results of a randomized clinical trial. American College of Rheumatology, 57(1), 77-85. doi:10.1002/art.22478
Siever, D. (2007). Audio-visual entrainment: history, physiology, and clinical studies. In J.R. Evans (Ed.) Handbook of Neurofeedback: Dynamics and Clinical Applications (pp. 155-183). New York: The Haworth Medical Press.
Solfanelli, G. (2009). Virtual Light and Sound Machine Meditation Freeware. Retrieved from www.thepsychologist.com/virtuallightandsound.htm
Spielberger, C. D., Gorsuch, R.L., & Lushene. R.E. (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.
Spielberger, C. D., Reheiser, E. C., Ritterband, L. M., Sydeman, S. J., & Unger, K. K. (1995). Assessment of emotional states and personality traits: Measuring psychological vital signs. In J. N. Butcher (Ed.). Clinical personality assessment: Practical approaches (pp. 52-53). New York: Oxford University Press, 1995.
Storch, M., Gaab, J., Küttel, Y., Stüssi, A., & Fend, H. (2007). Psychoneuroendocrine effects of resource-activating stress management training. Health Psychology, 26(4), 456-463. doi:10.1037/0278-6133.26.4.456
Taira, D. A., Wong, K. S., Frech-Tamas, F., & Chung, R.(2006). Copayment level and compliance with antihypertensive medication: Analysis and policy implications for managed care. The American Journal of Managed Care, 12(11), 678-683.
Tan, G., Dao, T. K., Smith, D. L., Robinson, A., & Jensen, M. P. (2010). Incorporating complementary and alternative medicine (CAM) therapies to expand psychological services to veterans suffering from chronic pain. Psychological Services, 7(3), 148-161. doi:10.1037/a0020304
Teplan, M. & Krakovska, S. S. (2006). Short-term effects of audio-visual stimulation on EEG. Measurement Science Review, 6(4), 67-70. Retrieved from
Tluczek, A., Henriques, J. B., & Brown, R. L. (2009). Support for the reliability and validity of a six-item state anxiety scale derived from the state-trait anxiety inventory. Journal of Nursing Measurement, 17(1), 19-28. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2776769.
Tracy, J. I., Ahmed, N., Khan, W., Sperling, M. R. (2007). A test of the efficacy of the MC Square device for improving verbal memory, learning and attention. International Journal of Learning Technology, 3(2), 183-202. doi:10.1504/IJLT.2007.014844
Tsai Sl (2004) Audio-visual relaxation training for anxiety, sleep, and relaxation among Chinese adults with cardiac disease. Res Nur Health 27(6):458-68.
Ulrich-Lai, Y. M., & Herman, J. P. (2009). Neural regulation of endocrine and autonomic stress responses. Nature Reviews Neuroscience, 10(1), 397-409. doi:10.1038/nrn2647
United States National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1978). The Belmont Report: Ethical principles and guidelines for the protection of human subjects of research. Ann Arbor: University of Michigan Library.
Van Dulmen, S., Sluijs, E., van Dijk, L., de Ridder, D., Heerdink, R., & Bensing, J. (2007). Patient adherence to medical treatment: a review of reviews. BMC Health Services Research, 7(55), 1-13. Retrieved from http://www.biomedcentral.com/content/pdf/1472-6963-7-55.pdf
Van Praag, H. M.(2004). Can stress cause depression? Progress in neuro-psychopharmacology and biological psychiatry, 28(5), 891-907. Retrieved from http://www.sciencedirect.com.
Wahbeh, H., Elsas, S., & Oken, B. (2008). Mind–body interventions: Applications in neurology. Neurology, 70(24), 2321–2328. Retrieved from http://www.ncbi.nlm.nih.gov
Walter, W. G. (1956). Color illusions and aberrations during stimulation by flickering light. Nature, 177, 710.
Williams, J., Teasdale, J., Segal, Z., & Kabat-Zinn, J. (2007). The mindful way through depression: Freeing yourself from chronic unhappiness. New York, NY: The Guilford Press.
Wolitzky-Taylor, K. B. (2009). Randomized clinical trial investigating the efficacy of self-administered interventions for reducing pathological academic worry. Retrieved from http://repositories1.lib.utexas.edu/handle/2152/7513
Wolpe, J. (1990). The practice of behavior therapy (2nd ed.). New York: Pergamon Press.
World Health Organization. (2010). WHO director-general's speech at the launch of the world health report. Retrieved from http://www.who.int/whr/2001/media_centre/dg_speech/en/index.html
Yapko, M. D. (2006). Hypnosis and treating depression: Applications in clinical practice. New York, NY: Routledge.
Ziegelstein, R. C. (2007). Acute emotional stress and cardiac arrhythmias. Journal of the American Medical Association, 298(3), 324-329. doi:10.1001/jama.298.3.324
Zobeiri, M., Moghimi, A., Attaran, D., Fathi, M., & Ashari, A. (2009). Self-hypnosis in attenuation of asthma symptoms severity. Journal of Applied Sciences, 9(1), 188-192. doi:10.3923/jas.2009.188.19
